This protocol addresses the specific presentation of chronic liver failure occurring in the setting of liver cirrhosis complicated by hypovolaemic hyponatraemia — a serum sodium below 130 mmol/L — notably in the absence of ascites and oedema.
Hypovolaemic hyponatraemia in cirrhosis is characterised by a marked loss of extracellular fluid and a prolonged negative sodium balance. Unlike hypervolaemic hyponatraemia, this form typically presents without ascites and without oedema. Excessive diuretic therapy is a common contributing factor. Identifying this distinction is essential before initiating management.
Management centres on identifying and removing the underlying cause, alongside plasma volume expansion. The complete stepwise regimen — including sequencing and clinical decision points — is available via the structured protocol.
As opposed to hypervolaemic hyponatremia, hypovolaemic hyponatremia is characterised by the frequent absence of ascites and oedema.
It is caused by a prolonged negative sodium balance with marked loss of extracellular fluid often due to excessive diuretic therapy.
The removal of the cause and administration of normal saline are recommended in the management of hypovolemic hyponatremia (III;1).
DOI: 10.1016/j.jhep.2018.03.024
View source ↗